Department of Medical Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015GD, Rotterdam, the Netherlands; Department of Surgical Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015GD, Rotterdam, the Netherlands.
Netherlands Comprehensive Cancer Organization (IKNL), Godebaldkwartier 419, 3511 DT, Utrecht, the Netherlands.
Eur J Cancer. 2019 Mar;110:98-106. doi: 10.1016/j.ejca.2019.01.005. Epub 2019 Feb 16.
Diagnosing and treating soft tissue sarcomas (STSs) remains challenging, stressing the urgency for centralisation. This nationwide survey aimed to evaluate the centralisation of STS surgery and its effect on survival.
Patients operated for primary STS from 2006 to 2015 were queried from the Netherlands Cancer Registry. Hospitals in which STS surgery was performed were allocated into three categories: low-volume (1-9 resections per year), medium-volume (10-19 resections) or high-volume (≥20 resections). Differences in tumour characteristics and outcome were calculated. A multivariable regression analysis was performed to adjust for case-mix.
Of the 5282 identified patients, 42% was treated in low-volume hospitals, 7.7% in medium-volume hospitals and 51% in high-volume hospitals, with a significant trend over time towards treatment in a high-volume hospital (p < 0.01). In high-volume hospitals, more often patients with non low-grade, large and deep-seated tumours were treated than in low-volume hospitals. For the whole group, there was no survival benefit for patients treated in high-volume hospitals, with 10-year net survival rates of 76% (low-volume), 68% (medium-volume) and 68% (high-volume). However, subgroup analysis for patients with non low-grade and deep-seated tumours did reveal a benefit from treatment in a high-volume hospitals with 10-year survival rates of 54% (high-volume), 49% (low-volume) and 42% (medium-volume) and a relative risk of 1.3 (high-volume versus low-volume, p = 0.03).
Centralisation of STS surgery has increased in the past decade. Surgery in a high-volume hospital improved survival of patients with non low-grade and deep-seated tumours, and therefore these patients should be referred to such a hospital.
诊断和治疗软组织肉瘤（STS）仍然具有挑战性，这凸显了集中治疗的紧迫性。这项全国性调查旨在评估 STS 手术的集中化程度及其对生存率的影响。
从荷兰癌症登记处查询了 2006 年至 2015 年间接受原发性 STS 手术的患者。对实施 STS 手术的医院进行分类：低容量（每年 1-9 例）、中容量（每年 10-19 例）或高容量（≥20 例）。计算肿瘤特征和结果的差异。进行多变量回归分析以调整病例组合。
在确定的 5282 名患者中，42%在低容量医院治疗，7.7%在中容量医院治疗，51%在高容量医院治疗，随着时间的推移，在高容量医院治疗的趋势显著（p<0.01）。在高容量医院，治疗的患者中非低级别、大肿瘤和深部肿瘤的比例高于低容量医院。对于整个组，在高容量医院治疗的患者没有生存获益，10 年无复发生存率分别为 76%（低容量）、68%（中容量）和 68%（高容量）。然而，对非低级别和深部肿瘤患者的亚组分析显示，在高容量医院治疗有生存获益，10 年生存率分别为 54%（高容量）、49%（低容量）和 42%（中容量），高容量与低容量相比，相对风险为 1.3（p=0.03）。
过去十年中，STS 手术的集中化程度有所增加。在高容量医院进行手术可提高非低级别和深部肿瘤患者的生存率，因此这些患者应转诊至此类医院。
